| Home Physician Assistant Services PC | |
|
2119 E 15th St Ste B1 Brooklyn NY 11229-4376 | |
| (718) 339-2901 | |
| Not Available |
| Full Name | Home Physician Assistant Services PC |
|---|---|
| Speciality | Family Medicine |
| Location | 2119 E 15th St Ste B1, Brooklyn, New York |
| Authorized Official Name and Position | Khaled Elbanna (MD) |
| Authorized Official Contact | 6463212331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Home Physician Assistant Services PC 2119 E 15th St Ste B1 Brooklyn NY 11229-4376 Ph: (718) 339-2901 | Home Physician Assistant Services PC 2119 E 15th St Ste B1 Brooklyn NY 11229-4376 Ph: (718) 339-2901 |
| NPI Number | 1639782972 |
|---|---|
| Provider Enumeration Date | 08/26/2020 |
| Last Update Date | 08/26/2020 |
| Certification Date | 08/26/2020 |
| Medicare PECOS PAC ID | 7315350659 |
|---|---|
| Medicare Enrollment ID | O20210106001326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639782972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Mark H Vine |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1386668010 PECOS PAC ID: 2466433602 Enrollment ID: I20040525001099 |
| Provider Name | Nick Nicoloff |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1992769632 PECOS PAC ID: 2668428913 Enrollment ID: I20050329001396 |
| Provider Name | Editha Lopez Quirino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306695960 PECOS PAC ID: 2860655966 Enrollment ID: I20240731002022 |
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